| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
68,003 |
65,591 |
$1.89M |
| D0120 |
Periodic oral evaluation - established patient |
69,354 |
66,910 |
$1.39M |
| D1206 |
Topical application of fluoride varnish |
78,008 |
75,405 |
$1.28M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,037 |
6,261 |
$1.04M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,134 |
7,882 |
$963K |
| D1351 |
Sealant - per tooth |
31,830 |
7,316 |
$710K |
| D1110 |
Prophylaxis - adult |
15,520 |
15,046 |
$588K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26,534 |
22,583 |
$490K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,323 |
5,652 |
$430K |
| D0272 |
Bitewings - two radiographic images |
25,097 |
24,224 |
$405K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,218 |
13,763 |
$380K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,164 |
3,373 |
$275K |
| D0330 |
Panoramic radiographic image |
8,856 |
8,568 |
$239K |
| D0274 |
Bitewings - four radiographic images |
10,091 |
9,820 |
$231K |
| D0210 |
Intraoral - complete series of radiographic images |
3,248 |
3,223 |
$166K |
| D0140 |
Limited oral evaluation - problem focused |
4,433 |
4,218 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
10,369 |
9,624 |
$111K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,554 |
4,231 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,669 |
2,419 |
$43K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
483 |
279 |
$33K |
| D0240 |
|
1,484 |
794 |
$20K |
| D1353 |
|
914 |
258 |
$19K |
| D7111 |
|
291 |
202 |
$12K |
| D7240 |
Removal of impacted tooth - completely bony |
58 |
16 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
123 |
106 |
$8K |
| D2332 |
|
88 |
56 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
289 |
283 |
$7K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
41 |
41 |
$3K |
| D9222 |
|
25 |
25 |
$2K |
| D1354 |
|
233 |
107 |
$1K |
| D2140 |
|
21 |
15 |
$1K |
| D2330 |
|
20 |
13 |
$975.97 |
| D0270 |
|
27 |
26 |
$165.32 |
| D0602 |
|
17 |
12 |
$0.00 |